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Related Experiment Videos

General practice fundholding: observations on prescribing patterns and costs using the defined daily dose method

M Maxwell1, D Heaney, J G Howie

  • 1Department of General Practice, University of Edinburgh.

BMJ (Clinical Research Ed.)
|November 6, 1993
PubMed
Summary

Fundholding practices in Scotland showed lower drug cost increases than non-fundholding practices over two years. Defined daily doses (DDD) offer a better way to track prescribing volume and costs for all practices.

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Area of Science:

  • Pharmaceutical policy
  • Health services research
  • Pharmacoeconomics

Background:

  • Prescribing patterns significantly impact healthcare costs and patient outcomes.
  • Accurate measurement of drug volumes is crucial for effective resource allocation and policy evaluation.
  • Fundholding practices were introduced to provide greater local control over prescribing budgets.

Purpose of the Study:

  • To compare drug prescribing patterns between fundholding and non-fundholding general practices in North East Scotland.
  • To evaluate the accuracy of drug volume statements using the World Health Organization's defined daily dose (DDD) methodology compared to standard National Health Service (NHS) statistics.

Main Methods:

  • A two-year retrospective analysis of prescription data from selected British National Formulary (BNF) sections was conducted.

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  • Prescriptions were converted to drug volumes using the World Health Organization's defined daily dose (DDD) mechanism.
  • Data were collected from six fundholding groups (nine practices) and six non-fundholding practices in the Grampian and Tayside regions of Scotland.

    • Main Results:

    • Both fundholding and non-fundholding practices reduced prescribing volumes for the analyzed drug classes over the two-year period.
    • Despite volume reduction, unit costs for some drug classes increased, leading to higher per-patient costs.
    • Unit cost increases were more pronounced in non-fundholding (control) practices (24%) compared to fundholding practices (11% in Tayside, 16% in Grampian).

    Conclusions:

    • Defined daily doses (DDD) effectively identified cost and volume trends in prescribing for both fundholding and control practices.
    • The current basis for setting fundholding budgets requires improvement.
    • DDD methodology could be valuable for setting volume targets for drug classes across all general practices, regardless of fundholding status.